MEDICARE: DR. CHANDRASHISH CHAKRAVARTY M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	TRN14096	FL

General Provider Information

NPI Number	:	1013240043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANDRASHISH CHAKRAVARTY M.D

Provider Business Mailing Address
First Line	:	1400 NW 10TH AVE
Second Line	:	APT 2009
City	:	MIAMI
State	:	FL
Zip	:	33136-1000
Country	:	US
Telephone Number	:	305-879-2292
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 NW 10TH AVE
Second Line	:	APT 2009
City	:	MIAMI
State	:	FL
Zip	:	33136-1000
Country	:	US
Telephone Number	:	305-879-2292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	09/09/2009

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